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SYSTEMIC PHARMACOLOGY > Gynae - vulva, vagina, uterus > Flashcards

Gynae - vulva, vagina, uterus Flashcards

1
Q

Infections of genitalia - 7 types of bacteria

A
  • Herpes virus
  • Molluscum contagiosum
  • HPV
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Candida
  • Trichomonas
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2
Q

pelvic inflammatory disease (PID) clinical symptoms (4)

A
  • pelvic pain
  • adnexal tenderness (abnormal growth near the uterus)
  • fever
  • vaginal discharge
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3
Q

diseases affecting vulva (3 types)

A
  • bartholin cyst
  • non-neoplastic epithelial disorders
    Lichen simplex chronicus, Lichen sclerosus
  • neoplasms
    (benign) hidradenoma, condylomas
    (malignant) VIN, SCC, Paget’s (vulva)
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4
Q

vulva paget’s disease

  • type of tumour
  • micro appearance
  • clinical appearance
  • prognosis
A
  • in-situ adenocarcinoma
  • atypical large cells
    confined to lining epithelium (basement membrane)
    arises from primitive ducts and spreads along lining epithelium
  • redness, exise area w/ margins
  • good prognosis
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5
Q

intraepithelial tumours (3)

A
  • VIN (Vulvar intraepithelial neoplasia)
  • VAIN (Vaginal Intraepithelial Neoplasia)
  • CIN (Cervical Intraepithelial Neoplasia)
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6
Q

diseases affecting vagina

A
  • Congenital anomalies
  • VAIN
  • Adenocarcinoma - caused by mother taking DES drug during pregnancy
  • Embryonal rhabdomyosarcoma = sarcoma botryoides
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7
Q

clear cell adenocarcinoma (CCA) of vagina

  • affects who
  • discoverable at what age
  • micro appearance
  • precursor
A
  • young women w/ mothers treated w/ DES drug during pregnancy
  • 15-20yrs
  • Vacuolated tumor cells in clusters and gland-like structures
  • precursor: vaginal adenosis = presence of glandular epithelium in vagina
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8
Q

Embryonal rhabdomyosarcoma = sarcoma botryoides

  • what type of tumour
  • affects who
  • treatment
A

botryoides = grape-like branches
rhabdomyosarcoma = tumour in soft tissue
- affects infants/children
- surgery + chemotherapy

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9
Q

cervical intraepithelial neoplasia (CIN)

  • types
  • where does it affect most commonly
A
  • CIN I/ II/ III
    (CIN I is the lowest grade w/
    mild dysplasia; CIN III - severe dysplasia/carcinoma in situ)
  • usually happens in the transformation zone (btw ectocervix and endocervix)
    simple columnar -> stratified squamous
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10
Q

CIN risk factors

A
  • Early age at first intercourse
  • Multiple sexual partners/ partner has multiple sexual partners
  • Increased parity (give birth many times)
  • cancer-associated HPV**
  • Certain HLA and viral subtypes
  • Exposure to oral contraceptives and nicotine
  • Genital infections (chlamydia)
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11
Q

cervical cancer screening

  • age group
  • frequency
A

25-69 yrs

every 3 years

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12
Q

HPV micro features

A
  • multinucleation
  • perinuclear halo
  • crinkled nuclei
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13
Q

cervical neoplasia -> cervical cancer pathogenesis (3 steps)

A
  1. HPV infection
    HPV disable protective functions of p53 and R8 -> unchecked cell proliferation**
  2. progression (1 year)
  3. invasion
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14
Q

cervical carcinoma gross appearance (3)

A
  • fungating
  • ulcerating
  • infiltrative
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15
Q

types of cervical carcinomas

A
  • Squamous cell carcinoma** (forms majority of cervical cancers)
  • Adenocarcinoma
  • Adenosquamous
  • Undifferentiated
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16
Q

3 types of squamous cell carcinomas

A
  • large cell non-keratinising
  • large cell keratinisng
  • small cell (SCC)
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17
Q

spread of cervical cancer

A
  • local invasion: (related structures) uterus, vagina, bladder, rectum
  • lymphatics
  • hematogenous (bloodstream): lung, liver, bone, brain
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18
Q

staging of carcinoma cervix

- what is it based on

A

based on local invasion

1: only cervix
2: upper vagina/ parametrium
3: pelvic wall/ lower vagina
4: rectum

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19
Q

diseases affecting uterine corpus

A
  • Endometrium – normal, polyps, hyperplasia, carcinoma, stromal neoplasms
  • Myometrium - leiomyomas, leiomyosarcoma, adenomyosis
  • Mixed mullerian tumour (carcinosarcoma)
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20
Q

diseases affecting endometrium of uterine corpus (lining of the uterus)

A
  • polyps
  • hyperplasia (cystic/ complex)
  • carcinoma
  • stromal neoplasm
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21
Q

diseases affecting myometrium of uterine corpus

A
  • leiomyomas (SM tumour)
  • leiomyosarcoma
  • adenomyosis - inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium)
22
Q

endometrial hyperplasia

  • cause
  • effect
  • 2 types
A

caused by unopposed estrogen stimulation + mutation of PTEN tumour suppressor gene
causes abnormal vaginal bleeding
- typical vs atypical hyperplasia
(atypical has higher risk of progressing to endometrial carcinoma)

23
Q

cystic hyperplasia micro appearance

A

Irregularly dilated glands

looks like proliferative glands

24
Q

complex hyperplasia micro appearance

+ complication

A

Glandular crowding and irregular shape

Loss of PTEN tumour suppressor gene -> High risk of cancer

25
Q

endometrial carcinoma**

- affects which age group

A

postmenopausal women

26
Q

causes of endometrial carcinoma (2)

+ risk factors**

A
  • prolonged estrogen stimulation (type 1)
  • p53 gene mutation (type 2)

risk factors: late menopause/early menarche.
obesity

27
Q

3 ways that prolong estrogen stimulation

A
  • Endometrial hyperplasia
  • Ovarian estrogen secreting tumours
  • ERT (enzyme replacement therapy)
28
Q

tumour caused by p53 gene mutation

  • prognosis
  • differentiation
A

(No preexisting hyperplasia)

  • Poor prognosis
  • Poorly differentiated serous type
29
Q

progress of tumour formed by prolong estrogen stimulation (type 1)
+ grading and prognosis

A 
proliferative endometrium
-> non-typical hyperplasia
-> typical hyperplasia
-> grade 1 uterine endometrial carcinoma
better prognosis than type 2
30
Q

staging of uterine endometrial carcinoma

  • stages
  • invasion of what structures
A

4 stages

1: Corpus only (affects majority)
2: Corpus & cervix
3: Invasion into pelvis
4: Outside pelvis

31
Q

leiomyoma of uterus

  • affects who
  • progression
  • complications
A

Most common uterine neoplasm
>30 yrs, regresses after menopause
- Increase in size with nuclear estrogen receptor/ progestins (hormones affecting progesterone receptor) and pregnancy
- presents w/ multiple tumours
stimulations of hormone receptors can cause increase in size + hemorrhagic degeneration

32
Q

leiomyoma of uterus

- which parts does it affect (4)

A
  • pedunculated (outside myometrium - uterine cavity/ outside uterus)
  • subserosal
  • intramural
  • submucosal
33
Q

clinical symptoms (3) + complications (2) of leiomyoma

A

(ABS - IS)

  • Abnormal bleeding (heavy menses)
  • Bladder compression
  • Sudden pain
  • infertility
  • spontaneous abortion
34
Q

leiomyoma **

  • gross appearance
  • histo features
A

red degeneration:

  • beefy red appearance due to rapid growth and infarction with subsequent haemorrhagic degeneration
  • well circumscribed, smooth round nodule in wall of uterus

histo:
- well circumscribed tumour w/ interlacing bundles of uniform spindled cells:
blunt ended nuclei and eosinophilic cytoplasm

35
Q

leiomyosarcoma

  • histo appearance
  • complications
A
  • Increased mitosis
  • necrosis
  • atypia

Metastasize to lungs/brain
low 5 year survival

36
Q

endometriosis definition

A

Presence of endometrial glands and stroma in abnormal locations outside the uterus

37
Q

endometriosis**

  • location
  • clinical symptoms
  • complications
A
  • mostly in abdominal cavity (undergoes cyclic bleeding even when it is not in the uterus)
  • dysmenorrhea (pain during menstruation)
    pelvic pain
    infertility
  • may progress to endometrial/ clear cell carcinoma
38
Q

adenomyosis**

  • definition
  • 2 types
A
  • ectopic endometrial deposits in MYOMETRIUM
    w/ overgrowth of muscle and connective tissue
- diffused (deposits confined within myometrium) - more common
vs localised (looks like fibroid, w/ brown coci)
39
Q

abnormal bleeding in prepuberty**

A 
precocious puberty (early puberty <8yrs)
hypothalamic/pituitary/ovarian problems
40
Q

abnormal bleeding in adolescence**

A

anovulation (lack of menses)

coagulation disorders

41
Q

abnormal bleeding in reproductive stage**

A 
pregnancy complications (abortion, trophoblastic disease, ectopic pregnancy)
leimyoma, adenomyosis, polyps, endometrial hyperplasia, endometrial carcinoma
42
Q

abnormal bleeding in perimenopausal stage**

A

dysfunctional uterine bleeding
anovulation
carcinoma, hyperplasia, polyps

43
Q

abnormal bleeding in postmenopausal stage**

A

endometrial atrophy

carcinoma**, hyperplasia, polyps

44
Q

investigations to identify etiology of bleeding

A
  • pelvic ultrasound
  • hysteroscopy (if u/s found to have endometrial polyp)
  • endometrial sampling
45
Q

treatment of polyps

A

hysteroscopic polypectomy

46
Q

treatment of adenomyosis

A

mirena (hormonal IUD - intrauterine device)

hysterectomy

47
Q

treatment of leiomyoma

A

myomectomy

hysterectomy

48
Q

treatment of malignancy

A

THBSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy)

49
Q

why does leiomyoma -> heavy menses?

A

tumour expands myometriumci - increase surface area of endometrial cavity (extra outpouching) -> increase shedding

50
Q

CIN III histo features

A
  • full thickness dysplasia of squamous mucosa
  • loss of maturation
  • cytologic atypia: cells have high n/c ratio, irregular nuclear membrane
51
Q

squamous cell carcinoma of cervix

  • histo features
  • diagnostic test
A
  • tumour invades into surrounding cervical stroma
  • presence of keratin pearls
  • intercellular bridges

cytokeratin stain positive

SYSTEMIC PHARMACOLOGY (22 decks)

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